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Designing Running Programs for Obese Individuals

Vincent, Heather K. Ph.D., FACSM

doi: 10.1249/FIT.0000000000000105
COLUMNS: Medical Report
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Heather K. Vincent, Ph.D., FACSM, is a National Institutes of Health fellowship–trained physiologist at the University of Florida (UF). She currently is serving as the director of the UF Health Sports Performance Center and the director of the Human Dynamics Laboratories in the Department of Orthopaedics and Rehabilitation at UF. She has published and presented extensively on the topics of obesity, exercise, and prevention of orthopedic injuries. She and her husband, Kevin Vincent, M.D., Ph.D., FACSM, live in Gainesville, FL, with their three sons.

Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

Running has rapidly increased in popularity (4) and is a highly attractive training option for attaining health and fitness. Overweight and obese people can achieve many health benefits from running, including a positive outlook, better self-esteem, improved muscle fitness, lowered cardiovascular and metabolic disease risk, and weight loss. However, obesity increases the load on weight-bearing joints such as the low back, hips, knees, and ankles. Muscles and soft tissues that support these joints also can be overloaded and injured. Supporting heavy weight during exercise also requires extra effort, and this may lower the enjoyment of the exercise. Health and fitness professionals must carefully balance the client’s desire to jog or run with the risk of developing weight-related musculoskeletal injury.

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SETTING GOALS FOR JOGGING AND RUNNING PROGRAMS

The client goals may not match what is realistic and safe when starting a running program. Novice runners may start running abruptly with the goal of participating in competitive events within weeks or a couple of months of starting to run. These patient goals are not realistic. Instead, among people with severe obesity with or without joint pain, a 3- to 4-year plan is realistic to transition to a running lifestyle without musculoskeletal injury. The demographic profile of the “typical runner” is changing. Overweight individuals interested in starting running are inclusive of women who want to shed pregnancy weight, those who are recently retired, and middle-aged persons wanting a lifestyle overhaul and appearance change. Proper guidance toward realistic goals and programs is essential to prevent musculoskeletal injury and ensure long-term success with a running lifestyle. The main goals for running programs in overweight and obese people should be:

  • Gradual weight loss
  • Avoiding injury
  • Enjoyment of training.
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INITIATING A RUNNING PROGRAM

A stepped approach that uses walking and running intervals to gradually increase the duration of running may work well for overweight novice runners. A walk-jog approach that uses intervals of running at higher speeds with recuperative bouts of walking in between may be appropriate because the distance is covered in a similar amount of time as sustained slower speed jogging. Irrespective of the targeted style of running program, the safe progression into regular running begins with regular walking. If joint pain or severe obesity does not permit the client to start running soon after initiating a program, an alternate approach of stationary cycle training coupled with reducing calorie intake for 3 to 6 months may be sufficient to increase fitness and start weight loss before running.

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Initial Walking Phase

Brisk walking is a recommended exercise for weight loss and is a good transition step toward running. The individual should focus on burning calories to stimulate some weight loss. Because overweight people carry a greater load during walking compared with a person of healthy weight, the calories used, joint forces, and effort levels will be higher than normal-weight people at any given walking speed. One way to help increase caloric burn is to shorten the stride length of each step, and this can increase the metabolic cost of walking by approximately 4.6% (2). Also, shorter steps reduce harmful joint forces acting at the knee and may help increase the use of body fat (3).

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Incline Walking

Treadmill incline walking can be used by novice exercisers if they cannot walk briskly or if joint pain is present. The initiation of a running program may include low to moderate incline (3% to 5% grade) walking at slower speeds (2 to 3.3 miles per hour) to boost calories burned and help with fat loss. Incline low-speed walking also may help reduce knee joint loading or redistribute mechanical stress loads across the load-bearing joints. This strategy may promote caloric expenditure with weight loss while preventing joint injury. One can expect that with an approximately 10% reduction in body weight, walking is easier, and this will make the transition to running much easier. The individual should choose the type of walking (outdoor or treadmill incline) that is most enjoyable to help encourage adherence in the early stages of the program.

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Walk-to-Run Transition Walking

If the individual is young, otherwise healthy, has no joint pain, and is willing to include more aggressive exercise, other training options may exist. Walking at the “walk-to-run transition speed” combined with dietary restriction may help provide a higher metabolic stimulus with less joint impact than running. The walk-to-run transition speed can be found by having individuals walk on a treadmill at increasing speeds until a threshold is reached where jogging is more comfortable than walking. After repeating this procedure a couple of times to ensure the proper speed is found, this can be the training speed for walking that is used during exercise sessions. Starting with session durations from 30 minutes and working up to 60 minutes at this speed, 3 times per week, is associated with approximately 9% body weight loss across 6 months (1). A potential concern is that this exercise modality challenges the muscles on the lower leg and may feel uncomfortable. To reduce overuse injury with this type of fast walking and maintain enjoyment of activity, permit at least 1 day of rest in between these sessions and moderate the number of consecutive days of exercise.

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Transition to Continuous Running

A natural strategy for overweight and obese persons is to move slowly to offset biomechanical stresses on the load-bearing joints. Therefore, the focus on the initial stages and progression of running should not be on speed but rather on caloric expenditure. As an obese person begins training, the increased caloric expenditure during activity likely will contribute to a faster initial rate of weight loss compared with the later stages as body weight decreases and plateaus. Weight loss will make exercise feel easier and facilitate the transition to continual running. Gradual exposure to increased training load with days of rest in between will permit bone tissues to “rest” and avoid mechanical failure.

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Intermittent Walk Jog/Run Programs

For obese persons, continuous intense running may be very hard. Intense intermittent walk-run exercise is endured more easily and may be a helpful approach for control of body weight. As training adaptations occur, the individual will be able to work at higher intensities and burn more calories compared with a person exercising at a moderate lower running speed. An important point for older overweight adults is that the walk-jog approach may be related to an increased risk for injury compared with younger counterparts. Potentially, this style or program may be better suited for younger novice runners who do not have any joint pain.

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KEY PROGRAM GUIDELINES

  • To prevent injury, do not progress exercise duration or mileage more than 5% per week.
  • If pain develops during the run and worsens as exercise progresses, or causes a limp, stop.
  • If any joint or soft tissue pain is present 24 hours after the exercise, the volume of exercise was too much and the intensity or duration needs to be reduced to allow more time for transition.
  • Allow a day of rest in between each run training day.
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PREPROGRAM CONSIDERATIONS

Obesity is related to strength deficits in different muscle groups. As muscles tire during exercise, gait patterns change that can contribute to the onset of injury. Obesity decreases postural control and balance, and novice runners who are obese should not be targeting running trails, warrior runs, or mud runs. Obese persons rely on ankle strength more than other leg muscle groups during walking and running. Once weight loss occurs and muscle strength is improved, the participant can better tolerate contact surface perturbations in the field. It would be sensible to begin strength training exercises before starting a running program and during the program to help maintain movement control. Key exercises include:

  • Plantar flexion, heel raises on floor or wobble board
  • Foot exercises using toes to pick up or move objects
  • Hip abduction (leg raises), bridges, and clamshells
  • Wall squats, lunges (supported and nonsupported), and side lunges
  • Single-leg balance
  • Lumbar extension
  • Abdominal bracing
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SUMMARY

Jogging and running can be important activities to help overweight people reduce the risk for obesity and prevent more weight gain across time. Compared with walking, higher-intensity jogging or running also reduces the risk of weight regain after intentional weight loss. Even light jogging can reduce fat and body weight, thereby reducing the significant health risks posed by obesity. Numerous factors need to be considered to ensure a safe transition from inactivity to long-term participation, including the degree of obesity, joint pain, or muscle strength.

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References

1. Beltaifa L, Chaouachi A, Zérifi R, et al. Walk-run transition speed training as an efficient exercise adjunct to dietary restriction in the management of obesity: a prospective intervention pilot study. Obes Facts. 2011; 4 (1): 45–52.
2. Browning RC, Kram R. Effects of obesity on the biomechanics of walking at different speeds. Med Sci Sports Exerc. 2007; 39: 1632–41.
3. Ehlen KA, Reiser RF, Browning RC. Energetics and biomechanics of inclined treadmill walking in obese adults. Med Sci Sports Exerc. 2011; 43 (7): 1251–9.
4. Running USA Web site [Internet]. Los Angeles (CA): Running USA; [cited 2014 August 26]. Available from: http://www.runningusa.org/index.cfm?fuseaction=news.details&ArticleId=1539&returnTo=annual-reports.
© 2015 American College of Sports Medicine.